Postoperative complications following simultaneous therapeutic and contralateral prophylactic nipple-sparing mastectomy: a retrospective study

Introduction: Nipple-Sparing Mastectomy (NSM) is increasingly indicated for therapeutic and prophylactic purposes due to better cosmetic results with nipple maintenance. Postoperative complications have not been compared among patients who have undergone simultaneous therapeutic and contralateral prophylactic NSM. The aim of the present study was to evaluate the incidence and risk factors for postoperative complications in bilateral/unilateral NSMs, and therapeutic and/or prophylactic NSMs. Methods: Retrospective study of patients who underwent NSM between 2007 and 2017 at A.C. Camargo Cancer Center. Results: Among 290 patients, 367 NSMs were performed, 64 simultaneous therapeutic and contralateral prophylactic NSM. The latter were associated with more postoperative complications (OR=3.42; p=0.002), mainly skin flap necrosis (OR=3.79; p=0.004), hematoma (OR=7.1; p=0.002), wound infection (OR=3.45; p=0.012), and nipple-areola complex (NAC) loss (OR=9.63; p=0.003). Of the 367 NSMs, 213 were unilateral NSMs, which were associated with lower rates of postoperative complications (OR=0.44; p=0.003), especially skin flap necrosis (OR=0.32; p=0.001), hematoma (OR=0.29; p=0.008), wound infection (OR=0.22; p=0.0001), and reoperation (OR=0.38; p=0.008). Obesity was related to more postoperative complications (OR=2.55; p=0.01), mainly hematoma (OR=3.54; p=0.016), reoperation (OR=2.68; p=0.023), and NAC loss (OR=3.54; p=0.016). Patients’ age (p=0.169), their smoking status (p=0.138), breast ptosis (0.189), previous chest radiotherapy (p 1), or previous breast surgery (p=0.338) were not related to higher chances of postoperative complications. Conclusions: Results suggest that performing therapeutic and contralateral prophylactic NSM as separated procedures may represent a good strategy for minimizing postoperative complications.

Parotidectomy

In this chapter, the history of parotidectomy is provided, and indications, contraindications, pre-operative planning, and the different techniques of parotidectomy procedures are described. These include different types of parotidectomy (superficial or lateral parotidectomy, radical parotidectomy, and extended total parotidectomy), limited procedures (partial superficial parotidectomy and extra-capsular dissection), and enucleation (extra-capsular and intracapsular). Indications include neoplasms, inflammatory lesions, salivary duct stones, and sialorrhea. Post-operative complications are discussed. These are either early complications (facial nerve palsy, bleeding/hematoma, surgical site infection, skin flap necrosis, salivary fistula/sialocele, seroma, external otitis, and trismus) or late complications (Frey's syndrome, hypertrophic scar/keloid, unsightly scar, soft tissue defect, and recurrence).

Cancer Metastatic to the Parotid Gland

Carcinoma metastatic to the parotid gland is a region-specific disorder. History usually reveals a previous cutaneous squamous cell carcinoma (SCC) or melanoma. Physical examination may show scars of previous operations, current head and neck lesions, associated lymphadenopathy, and altered sensation. Investigations include fiberoptic naso-endoscopy, fine needle aspiration cytology, computed tomography scan, magnetic resonance imaging, and positron emission tomography. Treatment options include surgery (ablative/reconstructive), radiotherapy (indicated for SCC and melanoma), chemotherapy (indicated for SCC), chemo-immunotherapy (may have a role for melanoma). Complications to avoid include (1) wound-related complications (skin flap necrosis and skin flap “button-hole” formation), (2) tumor-related complications (inappropriate surgery due to inadequate preoperative investigation or omitting neck dissection in patients with concomitant neck disease, tumor rupture, and local tumor recurrence), (3) gland-related complications (salivary fistula and sialocele), and (4) nerve-related complications (facial nerve injury, Frey's syndrome or gustatory sweating, and great auricular nerve neuroma).

Total conservative parotidectomy for management of benign parotid neoplasms

Background This study assesses the outcomes of total conservative parotidectomy in the management of benign parotid neoplasms. A retrospective review was conducted for all parotidectomies for benign superficial parotid neoplasms from 2013 to 2018. Facial nerve dysfunction, recurrence, and other side-effects were collected and statistically analyzed. Results A total of 21 patients were included in our study. Our series included a pleomorphic adenoma (16 patients), Warthin tumor (4 patients), and oncocytoma (1 patient). Overall, 12 patients had temporary facial nerve paresis (57.1%), 3 patients had temporary paralysis (14.3%)—no reported cases of permanent paralysis—and 6 patients sustained postoperative good facial nerve function (28.6%). No recurrence was reported in our study period. Other side effects included hemorrhage (1 patient), hematoma (2 patients), seroma (4 patients), and partial skin flap necrosis (2 patients). As well, Frey’s syndrome was reported in 11 patients, and most of them were managed conservatively. Conclusions Total conservative parotidectomy is a valuable approach for removing parotid tumors. The rate of complications after this procedure (facial nerve dysfunction and recurrence) is low provided that the technique was performed with meticulous care.